J Gynecol Oncol.  2014 Jul;25(3):206-213. 10.3802/jgo.2014.25.3.206.

Ultrasound guided conformal brachytherapy of cervix cancer: survival, patterns of failure, and late complications

• Narayan K
• van Dyk S
• Bernshaw D
• Khaw P
• Mileshkin
• Kondalsamy-Chennakesavan S

• KMID: 2130101
• DOI: http://doi.org/10.3802/jgo.2014.25.3.206

Abstract

OBJECTIVE
The aim of this study was to report on the long-term results of transabdominal ultrasound guided conformal brachytherapy in patients with cervical cancer with respect to patterns of failures, treatment related toxicities and survival.
METHODS
Three hundred and nine patients with cervical cancer who presented to Institute between January 1999 and December 2008 were staged with magnetic resonance imaging and positron emission tomography and treated with external beam radiotherapy and high dose rate conformal image guided brachytherapy with curative intent. Follow-up data relating to sites of failure and toxicity was recorded prospectively.
RESULTS
Two hundred and ninety-two patients were available for analyses. The median (interquantile range) follow-up time was 4.1 years (range, 2.4 to 6.1 years). Five-year failure free survival and overall survival (OS) were 66% and 65%, respectively. Primary, pelvic, para-aortic, and distant failure were observed in 12.5%, 16.4%, 22%, and 23% of patients, respectively. In multivariate analysis, tumor volume and nodal disease related to survival, whereas local disease control and point A dose did not.
CONCLUSION
Ultrasound guided conformal brachytherapy of cervix cancer has led to optimal local control and OS. The Melbourne protocol compares favorably to the more technically elaborate and expensive GEC-ESTRO recommendations. The Melbourne protocol's technical simplicity with real-time imaging and treatment planning makes this a method of choice for treating patients with cervical cancer.

Keyword

Brachytherapy; Cervix; Image-guided radiotherapy; Neoplasms; Radiation effects

MeSH Terms

Adenocarcinoma/pathology/radiography/secondary/ultrasonography
Adult
Aged
Brachytherapy/adverse effects/*methods
Carcinoma, Squamous Cell/pathology/radiography/secondary/ultrasonography
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
Prognosis
Prospective Studies
Radiation Dosage
Radiotherapy, Conformal/adverse effects/*methods
Treatment Failure
Ultrasonography, Interventional/*methods
Uterine Cervical Neoplasms/pathology/*radiography/ultrasonography

Figure

• 

  Fig. 1 Sagittal ultrasound view of uterus and cervix with treatment applicator in situ. Organ dimensions are obtained by measuring the distance from the applicator to the uterine cervix surface at 2.0 cm intervals along the applicator from the cervical stopper to the tip of the applicator. Source: Peter MacCallum Cancer Centre [6,8].

• 

  Fig. 2 Overall survival.

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